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目的分析肝内胆管囊腺瘤的临床特点及诊治方法。方法回顾性分析19例肝内胆管囊腺瘤患者的临床资料和随访结果。采用Cox回归分析对预后的影响因素进行分析。结果19例患者中男4例,女15例,平均年龄为49.9岁。患者以腹部不适为主要表现,有4例出现黄疸。影像学检查确诊5例(26.3%)。7例患者糖类抗原19-9(CA19-9)水平异常,19例患者甲胎蛋白(AFP)、癌胚抗原(CEA)水平均正常。19例患者中有15例行根治性手术,其中11例行肝叶切除手术,4例行肿瘤根治性切除联合胆总管取栓术;4例行姑息性手术。病理结果提示胆管囊腺瘤15例,其中4例伴局部不典型增生,2例伴中-重度不典型增生;肝内胆管乳头状囊腺瘤3例;胆管浆液性囊腺瘤1例。术式与患者的无瘤生存时间有相关性(β=4.174,P=0.014)。结论肝内胆管囊腺瘤以成年女性多见,多表现为腹部不适;影像学检查确诊率低;行根治性手术对患者有较好的预后。
Objective To analyze the clinical characteristics and diagnosis and treatment of intrahepatic cholangiocarcinoma. Methods The clinical data and follow-up results of 19 patients with intrahepatic cholangiocarcinoma were retrospectively analyzed. Cox regression analysis of prognostic factors were analyzed. Results Among the 19 patients, 4 were males and 15 were females, with an average age of 49.9 years. Patients with abdominal discomfort as the main performance, 4 cases of jaundice. Radiographic examination confirmed 5 cases (26.3%). Seven patients had abnormal levels of carbohydrate antigen 19-9 (CA19-9), and 19 patients had normal levels of AFP and CEA. Of the 19 patients, 15 underwent radical surgery, of which 11 underwent hepatectomy and 4 underwent radical resection combined with choledocholithiasis; 4 underwent palliative surgery. Pathological findings suggest that choledochal cystadenomas in 15 cases, of which 4 cases with atypical hyperplasia, 2 cases with moderate-severe dysplasia; intrahepatic biliary papillary cystadenoma in 3 cases; biliary serous cystadenoma in 1 case. There was a correlation between the surgical procedure and the patient’s tumor-free survival time (β = 4.174, P = 0.014). Conclusions Intrahepatic cholangiocarcinoma is more common in adult women, with more abdominal discomfort. The imaging diagnosis rate is lower. Radical surgery has a better prognosis for patients.